Provider Demographics
NPI:1407517840
Name:WELLSPRINGS MENTAL HEALTH SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:WELLSPRINGS MENTAL HEALTH SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:910-885-4849
Mailing Address - Street 1:2037 LAKERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0507
Mailing Address - Country:US
Mailing Address - Phone:910-885-4849
Mailing Address - Fax:
Practice Address - Street 1:511 N REILLY RD STE A-183
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2440
Practice Address - Country:US
Practice Address - Phone:910-580-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health